One-stage hybrid procedure for aberrant right subclavian artery and thoracic aneurysm

A 60-year-old man without any symptoms was referred to our department because computed tomography revealed an aberrant right subclavian artery (ARSA) and a saccular aortic aneurysm arising opposite to the ARSA. We performed the following procedures through a median sternotomy: total arch replacement, insertion of a frozen elephant trunk to exclude the aneurysm and ARSA, placement of a vascular plug under transesophageal ultrasonography to occlude the dilated ARSA, and right axillary artery bypass. Postoperative computed tomography showed complete occlusion of the ARSA and exclusion of the aneurysm. This procedure should be considered an alternative strategy for treatment of patients with an ARSA.